Comparison of the accuracy of the 7-item HADS Depression subscale and 14-item total HADS for screening for major depression: A systematic review and individual participant data meta-analysis

  • Yin Wu
  • Brooke Levis
  • Federico M Daray
  • John P A Ioannidis
  • Scott B Patten
  • Pim Cuijpers
  • Roy C Ziegelstein
  • Simon Gilbody
  • Felix H Fischer
  • Suiqiong Fan
  • Ying Sun
  • Chen He
  • Ankur Krishnan
  • Dipika Neupane
  • Parash Mani Bhandari
  • Zelalem Negeri
  • Kira E Riehm
  • Danielle B Rice
  • Marleine Azar
  • Xin Wei Yan
  • Mahrukh Imran
  • Matthew J Chiovitti
  • Jill T Boruff
  • Dean McMillan
  • Lorie A Kloda
  • Sarah Markham
  • Melissa Henry
  • Zahinoor Ismail
  • Carmen G Loiselle
  • Nicholas D Mitchell
  • Samir Al-Adawi
  • Kevin R Beck
  • Anna Beraldi
  • Charles N Bernstein
  • Birgitte Boye
  • Natalie Büel-Drabe
  • Adomas Bunevicius
  • Ceyhun Can
  • Gregory Carter
  • Chih-Ken Chen
  • Gary Cheung
  • Kerrie Clover
  • Ronán M Conroy
  • Gema Costa-Requena
  • Daniel Cukor
  • Eli Dabscheck
  • Jennifer De Souza
  • Marina Downing
  • Anthony Feinstein
  • Panagiotis P Ferentinos
  • Alastair J Flint
  • Pamela Gallagher
  • Milena Gandy
  • Luigi Grassi
  • Martin Härter
  • Asuncion Hernando
  • Melinda L Jackson
  • Josef Jenewein
  • Nathalie Jetté
  • Miguel Julião
  • Marie Kjærgaard
  • Sebastian Köhler
  • Hans-Helmut König
  • Lalit K R Krishna
  • Yu Lee
  • Margrit Löbner
  • Wim L Loosman
  • Anthony W Love
  • Bernd Löwe
  • Ulrik F Malt
  • Ruth Ann Marrie
  • Loreto Massardo
  • Yutaka Matsuoka
  • Anja Mehnert
  • Ioannis Michopoulos
  • Laurent Misery
  • Christian J Nelson
  • Chong Guan Ng
  • Meaghan L O'Donnell
  • Suzanne J O'Rourke
  • Ahmet Öztürk
  • Alexander Pabst
  • Julie A Pasco
  • Jurate Peceliuniene
  • Luis Pintor
  • Jennie L Ponsford
  • Federico Pulido
  • Terence J Quinn
  • Silje E Reme
  • Katrin Reuter
  • Steffi G Riedel-Heller
  • Alasdair G Rooney
  • Roberto Sánchez-González
  • Rebecca M Saracino
  • Melanie P J Schellekens
  • Martin Scherer
  • Andrea Benedetti (Shared last author)
  • Brett D Thombs (Shared last author)

Abstract

The seven-item Hospital Anxiety and Depression Scale Depression subscale (HADS-D) and the total score of the 14-item HADS (HADS-T) are both used for major depression screening. Compared to the HADS-D, the HADS-T includes anxiety items and requires more time to complete. We compared the screening accuracy of the HADS-D and HADS-T for major depression detection. We conducted an individual participant data meta-analysis and fit bivariate random effects models to assess diagnostic accuracy among participants with both HADS-D and HADS-T scores. We identified optimal cutoffs, estimated sensitivity and specificity with 95% confidence intervals, and compared screening accuracy across paired cutoffs via two-stage and individual-level models. We used a 0.05 equivalence margin to assess equivalency in sensitivity and specificity. 20,700 participants (2,285 major depression cases) from 98 studies were included. Cutoffs of ≥7 for the HADS-D (sensitivity 0.79 [0.75, 0.83], specificity 0.78 [0.75, 0.80]) and ≥15 for the HADS-T (sensitivity 0.79 [0.76, 0.82], specificity 0.81 [0.78, 0.83]) minimized the distance to the top-left corner of the receiver operating characteristic curve. Across all sets of paired cutoffs evaluated, differences of sensitivity between HADS-T and HADS-D ranged from -0.05 to 0.01 (0.00 at paired optimal cutoffs), and differences of specificity were within 0.03 for all cutoffs (0.02-0.03). The pattern was similar among outpatients, although the HADS-T was slightly (not nonequivalently) more specific among inpatients. The accuracy of HADS-T was equivalent to the HADS-D for detecting major depression. In most settings, the shorter HADS-D would be preferred. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Bibliographical data

Original languageEnglish
ISSN1040-3590
DOIs
Publication statusPublished - 02.2023
PubMed 36689386